This is the first study to investigate a potential connection between anthracycline chemotherapy and risk of heart failure (HF) in young adult cancer survivors.
Among a cohort of young adult (YA) cancer survivors who received their diagnosis between January 2000 and January 2019 and were treated with anthracycline-based chemotherapy vs those who were not, there was a higher 5-year incidence of heart failure and an overall higher risk of incident heart failure.
The study published in JACC: CardioOncology1 was conducted among patients receiving cancer care within the Northwestern Medicine system. There were 738 patients with cancer who had anthracycline exposure from among the total patient population of 12,879; for this analysis, anthracycline exposure included patients with a diagnosis of leukemia, lymphoma, and breast, kidney, and orthopedic cancers (bone and sarcomas), “cancer types commonly treated with anthracycline chemotherapy,” the authors wrote. Their outcomes were compared with all other cancer types in YA patients.
Long-term exposure was paramount. Therefore, patients with less than 6 months of follow-up were excluded. The mean (SD) overall age was 31.5 (5.7) years at cancer diagnosis, mean body mass index was 26.7 (6.6) kg/m2, 65% of the patients were women, and 68% reported a White race. Breast was the most common cancer seen, followed by lymphoma, thyroid, and melanoma, in 17.2%, 14.8%, 12.6%, and 11.0%, respectively.
“We often think about heart failure as a disease people get when they are old, but this work highlights that this is also a short-term risk for patients who survive cancer,” said Sadiya Khan, MD, MSc, assistant professor of cardiology and epidemiology at the Feinberg School of Medicine and a Northwestern Medicine physician, in a statement.2 “It raises awareness for patients and clinicians to monitor symptoms and consider strategies for prevention.”
There were 180 incident heart failure events and 714 deaths over a median (IQR) follow-up of 3.4 (1.3-7.1) years. The mean age at heart failure diagnosis was 31.6 (5.7) years.
The 5-year rate of heart failure was more than doubled in the anthracycline-treated cohort vs those with no exposure: 4.0% vs 1.3% (P < .01), or 9.6 (95% CI, 6.3-14.4) vs 2.9 (95% CI, 2.4-3.5) per 1000 person-years, respectively. In addition, the risk of incident heart failure was 2.6 times higher (95% CI, 1.6-4.9; P < .01). Even when adjusting for competing risk of death in the anthracycline group, the risk of incident heart failure remained high, at 2.4 (95% CI, 1.5-3.7; P < .01).
Drilling down to the specific cancer diagnosis within the anthracycline cohort, patients with leukemia had the highest 5-year incidence of heart failure compared with breast, kidney, and orthopedic cancers and lymphoma.
There was also a greater risk of early-onset heart failure among the YA cancer survivors, in addition to the overall higher risk of heart failure.
These findings add to those of the Childhood Cancer Survivor Study that show a greater likelihood of heart failure (HR, 5.9; 95% CI, 3.4-9.6) among childhood cancer survivors (younger than 21 years at diagnosis) compared with their health siblings—although this outcome was not a goal of that analysis.
Because of the present study’s lack of diversity and that some patients were missing data on their chemotherapy dose, radiation treatment, and cardiovascular disease risk factors, these findings may not be generalizable to a wider audience.
“Longer term longitudinal studies are needed among diverse YA cancer survivors with adjudicated outcomes,” the authors concluded, “to better understand the combined impact of cancer treatment and traditional CVD risk factors on YA health and longevity.”
1. Hibler E, Tanaka Y, Akhter N, et al. Risk of incident heart failure among young adult cancer survivors. J Am Coll Cardiol CardioOnc. Published online May 16, 2023. doi:10.1016/j.jaccao.2023.03.009
2. Some young cancer survivors face higher risk of premature heart failure. News release. Northwestern Now. May 16, 2023. Accessed May 30, 2023. https://news.northwestern.edu/stories/2023/05/some-young-cancer-survivors-face-higher-risk-of-premature-heart-failure/?fj=1